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Biomedical subjects

P Beaufils

Publications and source records attributed to P Beaufils.

At least 109 records · Page 6Linked to original sources
PubMed1985

[Idiopathic dilatation of the heart atrium with complete auricular paralysis].

The authors report the case of a patient with idiopathic dilatation of the auricles and complete atrial paralysis associated with absence of excitability of the atrial muscle. Repeated echocardiograms over a period of three months demonstrated dilatation of the auricles and ventricles with the development of mitral and tricuspid incompetence. The role played by the junctional bradycardia in the ventricular dilatation is discussed and the patient was explored haemodynamically with varying rates of ventricular pacing. In view of the improvement in the haemodynamic parameters, a cardiac pacemaker was inserted. After a follow-up of one year, the ventricular chambers have returned to normal and the mitral and tricuspid incompetence has regressed, while the atrial muscle continues to dilate. The patient is currently asymptomatic with no medical treatment.

Adult↗
PubMed1985

[Coronary angiography and coronary bypass in patients over 70 (valvular disease excluded). Indications and results].

Between 1982 and 1984, 30 patients aged 70 or over underwent coronary angiography for isolated coronary artery disease, complicated in 8 cases by an infarct and uncontrolled by major medical treatment, including triple therapy on 28 mmHg (range 5-30 mmHg). Coronary angiography was performed under intravenous trinitrin in 9 cases, under intra-aortic balloon pumping in 1 case, without any serious complications. The majority of patients had triple vessel disease (18 cases) and stenosis of anterior interventricular (27 cases). The left main stem was diseased in 5 patients. Twenty-four patients, with an EF of over 0.40, underwent a coronary bypass with an average of 27 grafts/patients; 4 myocardial infarcts and 5 postoperative deaths were observed. Nineteen patients survived at medium term follow-up and had an excellent clinical result. Of the non operated patients, there was one early death and 3 patients remained severely incapacitated. In the absence of a major contra-indication to surgery, coronary angiography can be offered to patients over 70 years old in cases of severe coronary insufficiency, resistant to major medical treatment. Coronary bypass is justified by the spectacular functional improvement which it alone can bring about.

Age Factors↗
PubMed1984

Ventricular function and arterial compliance in patients with congestive cardiomyopathy.

In order to study the interrelationship between left ventricular afterload, estimated from the mean left ventricular wall stress, and the mechanical properties of the aorta, we have simultaneously measured systemic arterial compliance and left ventricular wall stress in 19 patients with congestive cardiomyopathy. The strong linear relationship between the ejection fraction of the left ventricle and systemic arterial compliance, and between left ventricular wall stress and systemic arterial compliance, suggests that systemic arterial compliance is an important determinant of left ventricular afterload and thus of left ventricular function.

Adult↗
PubMed1984

[Epiphyseal fixation with an external fixator. Biomechanical and clinical study].

Fifty one fractures of an epiphysis were treated by fixation using a new external fixator. The stability of the fixation was compared with that obtained by other types of fixator. The basis of the technique was the insertion of five pins into the epiphysis and of a series of pins in the diaphysis. Fixation between the epiphyseal and diaphyseal pins was achieved by three bars. The results obtained in 38 cases, half of them being at the proximal end of the tibia were analysed and were found to be encouraging. Only three had to be grafted secondarily. There was a low number of mal-unions. The main advantage of this method was to allow early mobilisation of the joint. The risk of sepsis did not give rise to concern provided that the rods do not cross the joint.

Biomechanical Phenomena↗
PubMed1984

[Arthritis of the hip in paraplegic patients. Apropos of 8 cases].

Eight instances of septic arthritis of the hip were treated in 6 paraplegics. On each occasion the hip had been infected through a nearby ulcer. In 2 cases the diagnosis was only made at operation because signs of a severe infection are not obvious in paraplegics. The radiographs were often misleading, the joint space being either normal or narrowed even before the onset of sepsis. The treatment combined antibiotic therapy with resection of the head and neck stabilized by external fixation for 45 days. The procedure was only successful in 5 cases out of 8 as far as infection was concerned. The resection did not impair ability to sit in this type of patient.

Adult↗
PubMed1984

[Tibiotarsal arthrodesis in a septic milieu].

The authors have performed 28 ankle fusions for septic causes. There were 23 cases of septic arthritis and 5 severely comminuted compound fractures treated by primary fusion. Arthrodesis was made after wide excision and stabilization by external fixator. In 23 cases secondary bone grafting was done. Only in 13 cases was a satisfactory contact between the bony surfaces obtained. There was no contact at all in 9 cases. The authors have had good experience with the A.L.J. model of external fixator. On 7 occasions, secondary grafting was made using a cortico-cancellous graft with 3 failures. On 6 occasions, the Papineau technique was used with success but healing was slow. Out of 24 patients, the final result was good in 18 with 4 failures of fusion and 3 persistent sinuses. The importance of a wide excision is emphasised leading to the need for the use of external fixation. In cases of skin loss in recent comminuted fractures, the Papineau method is indicated as a primary procedure.

Adolescent↗
PubMed1984

[Acute myocarditis simulating an anterior infarction rupture. Apropos of 2 cases].

The first case report concerns a 31 year old woman presenting clinically and electrocardiographically as an anteroseptal myocardial infarction complicated by cardiogenic shock with equalization of right heart diastolic pressures. Coronary angiography performed under circulatory assistance was normal. The patient recovered, and clinical examination 4 years after the acute episode is absolutely normal. The second case was a 37 year old man admitted in cardiogenic shock thought to be due to a large anterior myocardial infarct. Catheterisation showed equalization of right heart diastolic pressures. Pericardial aspiration was negative and the most likely diagnosis appeared to be a localised rupture of the heart. The patient underwent emergency cardiac surgery but no infarct scar was observed and opening the pericardium did not improve the haemodynamics. Coronary angiography was carried out at the 24th hour under circulatory assistance and was found to be normal. The diagnosis was corrected to that of acute myocarditis and 5 months after the acute episode clinical cure was confirmed by normal echocardiography and angiography. The only positive aetiological finding in this case was the serology to chlamydia trachomatis which as strongly positive at increasing titres. Chlamydia was isolated from the patient's urethra and a chlamydia trachomatis exocervicitis was also found in the partner. This appears to be the first reported case of chlamydia trachomatis acute myocarditis in the adult.

Acute Disease↗
PubMed1983

[Treatment of cardiogenic shock in acute myocardial infarction and postoperative low cardiac output].

The extent of myocardial and coronary lesions, the failure of the mechanisms regulating coronary blood flow, and the inadequacy of adrenergic stimulation account for the difficulties in managing cardiogenic shock as a complication of acute myocardial infarction. Except in cases of hypovolemia, excessive bradycardia, the only adequate treatment is IABP. However, long-term survival is observed only in patients undergoing surgery for a mechanical complication after control of the cardiogenic shock. Finally, the causes of the post-CPB low output syndrome and the principles of their management are discussed.

Age Factors↗
PubMed1983

[Complex injuries of the upper end of the 2 forearm bones].

Thirty-four cases of severe trauma to the proximal ends of both bones of the forearm have been seen. All were treated surgically. A classification is proposed related to the site of the ulnar fracture. Type I is metaphyseal and the displacement is posterior, the reverse of that of a Monteggia fracture, with a posterior dislocation of the superior radio-ulnar joint. Type II is epiphyseal with anterior displacement. The superior radio-ulnar joint is intact. Type III is metaphysio-epiphyseal with anterior displacement. Type IV is the same with posterior displacement. Fractures of the radial head are present in all cases with posterior displacement and in these types, secondary displacements and non-unions are frequent (six cases). These were related to inadequate fixation of the ulna and to resection of the radial head which led to an increased strain on the ulnar fracture. Severe limitation of movements was infrequent (five cases) and was usually seen in fractures with posterior displacement. It was related to the time of cast immobilization and to the fracture of the radial head. Fractures with anterior displacement and an associated fracture of the radial head were rare but had a better prognosis in spite of the intra-articular site of the fracture. The relevance of repair of the radial column is stressed as being as important as stable fixation of the ulnar fracture.

Adolescent↗
PubMed1983

[Arthroscopic meniscectomies. Short- and median-term results].

Two hundred and forty arthroscopic meniscectomies have been performed between 1980 and 1982. One hundred and ninety-eight cases have been reviewed with a follow up of between 3 and 6 months and 101 cases were reviewed with a follow up of between 6 months and 2 years. On eight occasions the arthroscopy had to be completed by an arthrotomy and one of these became septic. No sepsis was observed in the absence of arthrotomy. Three cases of phlebitis and one haemarthrosis were seen. Social and functional rehabilitation was very rapid. The stay in hospital was 2 days and resumption of sport and work was 2 or 3 times more rapid than after meniscectomy by arthrotomy. The results were excellent or good in 85 p. 100 of cases, slightly better than after arthrotomy. The prognosis was worse when there were patellar or tibio-femoral chondral lesions, and the results were not as good in lateral meniscus lesions, and particularly when there was an associated lesion of the anterior cruciate ligament. However, two patients out of three with this condition were noticeably improved. The remainder will possibly have a secondary repair of the anterior cruciate ligament. The present follow up is not sufficient to evaluate long-term results but the fact that meniscectomy was partial in 3 cases out of 4 supports the hope that the results will be stable. It is only later that it will be possible to evaluate the unobserved lesions or the incidence of recurrence.

Adolescent↗
PubMed1983

[The value of temporary electrosystolic pacing for treating low output in posterior necrosis with adiastole].

Early catheterisation was performed in 27 patients with an acute inferior myocardial infarction less than 3 days old complicated by signs of low output with right ventricular dysfunction. All patients had hemodynamic criteria of adiastole (PCP = 14.9 +/- 31 mmHg and LVEDP = 14.1 +/- 4.7 mmHg) with low cardiac output (CI = 1.41 +/- 0.32 l/min/m2). An atropine resistant bradycardia was characteristic (HR = 65 +/- 17.2/min) due to advanced or complete AV block (11 cases), sinoatrial block (3 cases, one with right atrial standstill) or sinus/parasinus rhythm (13 cases) inappropriate to the severity of their hemodynamic state. Although the prognosis based on the discriminating linear function FI = -0.427 + 0.00121 LVW - 0.00125 TPR was initially poor and predicted the death of 21 out of the 27 patients at one month, the outcome was usually favourable and only 8 patients died during the first month. Fifteen patients were treated by temporary endocavitary RV pacing. As the heart rate was increased from 53.8 +/- 11.2 to 92.4 +/- 4.9/min, the CI rose from 1.35 +/- 0.26 to 1.85 +/- 0.46 l/min/m2 (p less than 0.001) with a fall in SI from 26.7 +/- 8.3 to 20.1 +/- 5.6 ml/beat/m2 (p less than 0.005). The results were even further improved in 3 cases by sequential A-V pacing. The observed hemodynamic improvement continued during the period of pacing providing volumic expansion maintained LVEDP above 10 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)

Arrhythmias, Cardiac↗
PubMed1982

Effects of acebutolol on myocardial infarct extension: a randomized electrocardiographic, enzymatic and angiographic study.

The effect of acebutolol (1 mg/kg i.v. during the first 2 days followed by a daily oral dose of 600 mg for 3 weeks) was studied in a randomized trial involving 26 patients seen within 24 hours after the onset of uncomplicated anterior transmural myocardial infarction (TMI). Myocardial ischemia and necrosis were evaluated by precordial maps recorded daily for 9 days. Left ventricular pump function and dyssynergy were quantitatively measured on 30 degrees right anterior oblique cineangiograms. Angiography was performed, using the postextrasystolic potentiation technique, within the first 24 hours after TMI and was repeated 1 month later. The basal and postextrasystolic beats from the initial angiography were computerized and compared with those from the final angiogram. MB-CK serum level was measured from blood samples drawn every 3 hours for the first 72 hours. Fourteen patients selected at random received acebutolol within the first 24 hours; 12 subjects were untreated and served as controls. During the 1-month study, no other drugs were administered. Treated patients showed a significant reduction in capillary wedge pressure, extent of hypokinesis and ST-segment elevation; no significant differences were observed in the control group. However, the predictability based on the angiographic data was the same in both groups, and beta blockade did not alter this predictability significantly. Furthermore, no significant difference was found during the final evaluation for treated compared with control patients for any single variable or set of variables. The incidence of infarct extension was not decreased, but only significantly delayed in treated patients. The high variability of the measurements, probably related to the high variability of the pathophysiologic factors, may account for the failure to demonstrate the efficacy of acebutolol.

Acebutolol↗